Tuesday, July 28, 2009

Fourth Year Is....

I'd finish the sentence, but I don't have to. That's the beauty of fourth year. When you're a third year, as soon as someone asks you what year you're in, a wince comes over your face and you kind of mumble, "third year." It's a sad moment because now you both know it is now their duty to wipe the floor with you.

In your third year, sure, your job is to go through all the different rotations and learn medicine. But really, it's just as much a year where you have to learn you are Medicine's bitch. Just in case you think you could have a life outside of medicine, they put you through third year and slap you around until you wish you'd never gone to medical school. When I was a student rep for a medical school faculty committee, a girl wanted to take two years to do her third year because she wanted time off to have her baby. They said a resounding "NO"; for the reason, as one doc put it, that "third year is supposed to be 12 months of learning that Medicine is hard." She was already pregnant, so I don't know what she did. Probably dropped birth in the middle of a 9-hour urology surgery, handed the kid off to a nurse, and kept going with the very important job of holding the scrotum.

Fourth year is totally different. When you tell someone you're a fourth year, you're instantly buddies. I think this is because fourth year medical school, with the exception of a few months, is the best year you'll ever have again. Fourth year is the reason you go to medical school. Or at least it should be. Through policies and scheduling, it is made to be almost completely blown off.

My fiance, baffled by this change from third year to fourth year, observed the other morning, "You get to go to work in pajamas. Every day." It's true, and it is just glorious. That day it was especially true because I didn't feel like putting much effort into the day and just pulled scrubs on over what I had slept in the night before. So yeah, I technically went to work in pajamas.

Radiology is probably the most amazing rotation. Not just because its what I want to do, but because you are actively encouraged not to attend your own rotation. The first time a resident offers to let you go home, you have to ho hum and "well, I'm really interested in this" and somehow try to show that you give a crap and want good evals (especially if you want to go to that residency). The second and third time they tell you, you're probably in the way and should just give it up. After you cross that bridge its hard to go back. Yesterday I made the faux pas of coming back to the reading room after noon (I had a lecture later and had to be there anyway). As soon as the attending left, the resident twirled around in his chair and said, "so, has anyone told you how this rotation works?" "You mean, why am I here after noon?" I asked. "Well, basically, yeah." he said. "Welp, see ya later."

Hmm dee hum hum, I think I might go get ready now. Meaning I'll put my pajamas back on, waste time for an hour or so, and roll into work about 9. This is the best year ever.

Thursday, July 23, 2009

Candy Gram! Updated

I'm back. And boy do I have a story for you.

I watched someone poop yesterday. You know, now that I think about it, I've done that before. I did work in a nursing home after all. But this time felt a little different. Maybe that's because we took pictures. And she was sitting five feet up in the air. And we shot her full of radioopaque poo to do it.

I was sent to fluoroscopy (which as far as I can tell is where you stick contrast in one hole or the other and watch where it goes with x-rays.) because there are quite a few future radiologists vying for a spot here. The resident said, "Well, you picked a boring day. Nothing really going on except two defecographies." Defe-what?

Wait. I know what that root word means.

But there's already something called a barium enema, where Dr. Feelgood shoots your backdoor full of contrast and takes a picture. Why would we ever need to watch someone push it back out? "Really, no one does it anymore, we just have one doc who orders it. A lot." said the resident. Oh my. That's something that scares me about medicine. If you went to my home institution, you'd never hear of the crap-o-gram. But here some doc with a fetish has people going right and left.

As we were getting ready, I walked into the room where the tech was prepping the caulk gun. "So, is it go time?" I asked. Then I laughed really hard.

So this already sounds pretty terrible. But then he started to describe the procedure. I'll do my best to recreate it and my reactions.

First you make the person drink contrast (no, of course it doesn't taste good). This is so their bowel and bladder lights up a little and you can tell where they are on the film.

Next, if it's a lady patient, you have her go insert a contrast soaked Tampon so you know where all the parts are.

After that fun, the patient lays down on a table, business end skyward, while you (the unfortunate resident in this case) take a caulk gun basically from a hardware store --apparently, if you say "surgical grade" it covers all manner of sins--filled with a radio-opaque putty (it really looks like caulk-hence the equipment I suppose), and pump. You know where. I can barely type this, this is horrifying. To add injury to insult, it's very hard to pump the stuff, so you try to go as fast as you can without getting a debilitating cramp. You wouldn't want to try to switch to lefty in the middle of this.

I'm not even done. After that, the patient holds it in and goes to sit on a chamber pot in front of the x-ray machine. Here's something hilarious; the x-ray camera arm doesn't go low enough to capture the action on the chamber pot, so the patient+potty combo gets lifted in the air several feet while on the pot.

Then the real fun starts. First we just take a picture, I guess to see if there's any leakage while you're just minding your business. I would think that a patient wouldn't need defecography to figure out if that were happening (wouldn't you be able to tell if you were, ahem...you know?), but who am I to judge Medicine? "Ma'am, I want you to bear down as if you were having a bowel movement, but try not to actually go." I about lost it at this point. I already need two doors and an alibi, I would never be able to go through this. Then we took another picture, I think looking for angles and outpouchings and other things that won't probably affect the treatment. "Ok, now go." More pictures. I just spent ten minutes watching someone poop from the inside out. And there is no fan or springtime lemon air-freshener spray in the room-I discretely stepped out so I wouldn't reenact the scene from my surgery foley catheter disaster. I really need to figure out a way to dumb down my sense of smell. I used to be able to switch automatically and mouth breathe at the nursing home, but honestly that is just as gross.

This woman took it like a trooper. After she was in the bathroom the resident asked the nurse, "So, this is the room we're doing all these in now?" The guy replied, "Yeah, the equipment in the other room is really crappy." The snort was out of my mouth before I knew it was coming. Luckily the young female tech student caught the joke too. Apparently he wasn't kidding though; during the middle one of these procedures the x-ray quit and they had to LOWER THE PATIENT AND TAKE HER TO ANOTHER ROOM while she was holding a rectum full of putty!

When I was looking for images I noticed Rush University had a lot on their website about this. HA! Get it? RUSH!

If I didn't laugh, I'd probably throw up.

Wednesday, July 22, 2009


I was out of town for a few weeks. I should have posted a warning. I will be back with a post today. I've already started it, but feel it will take me a little longer to describe watching someone poop on camera.